And this is for good reason — we are a culture that is becoming more accustomed to having ways for combating diseases and illnesses that can spread through our population like wildfire. Add to this concerns for global epidemics, as well as the potential for yet-to-be-named strains of new bacteria and viruses.
The fire service has been on the front lines for the threats of anthrax, SARS, and H1N1. Firefighters have been taught universal precautions in assuming that any victim blood and body fluids are contaminated with HIV and Hepatitis.
Further, we hear of cases in various fire departments where their members have come in contact with drug-resistant tuberculosis and other persistent respiratory diseases.
While there are issues concerning how well firefighters are protected from biological hazards, there are many questions on how to deal with the aftermath of such exposures.
Is your protective gear a continuing source of exposure?
From a biological standpoint, what does decontamination mean and how is it accomplished?
Is washing in hot water with a detergent sufficient to kill most harmful microorganisms?
Should you be using a disinfectant, a sanitizer, or an anti-microbial treatment on your gear, and if you do, how do you know which one to choose?
And, what should you do to minimize your risk to disease or pathogen exposure?
Infection control takes many forms, including the practice of universal precautions, good hygiene, and the proper use and care of protective clothing and equipment.
The National Fire Protection Association has written an entire standard on this subject. "NFPA 1581, Standard on Fire Department Infection Control Program," specifies the mandatory procedures each department should implement from providing immunizations and infectious-disease screening to proper hygiene and cleaning/disinfecting stations, apparatus and equipment.
Unfortunately, provisions for how personal protective equipment is decontaminated are not explicitly described except to follow the manufacturer’s instructions. "NFPA 1851, Standard for Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting," offers little additional detail.
Therefore, many of the aforementioned questions remain unanswered.
Getting it clean
One of the more significant questions is how to clean turnout clothing when you suspect it has been contaminated with blood, body fluids or other potential pathogen-containing fluids. First, exercise special care when handling such clothing, especially in its removal and isolation. Such care is aimed at preventing the further spread of contamination to yourself and others.
Most departments recognize that clothing under these conditions must be isolated, tagged and bagged with its identification as biologically contaminated items. Those who clean the gear must wear eye and face protection, cleaning gloves and aprons.
Specialized cleaning must be done to ensure that the biological contamination is both inactivated and removed. Sometimes, this can be accomplished by standard cleaning using appropriate detergents, water conditions and numerous rinse cycles — often combined with certain pretreatment regimens applied to the clothing and special additives used in the wash cycle.
The combination of hot water and detergents is effective in removing many biological contaminants. Yet, it is often necessary to take other steps to be sure that any microorganisms present are completely killed.
There is an array of products and processes claiming disinfection, sanitization or anti-microbial treatments with clothing during laundering or decontamination. Often such terms are used interchangeably, but there are important distinctions and requirements for anything where a specific claim is used in conjunction with these terms.
Understand the agents
To understand the legitimacy of any claims for a disinfectant, sanitizer or anti-microbial treatment, you must understand that these terms have different meanings.
A disinfectant is a type of anti-microbial agent that destroys or irreversibly inactivates microorganisms on hard, inanimate surfaces and objects. Hard, non-porous surfaces do not include the textile products used in firefighter protective clothing.
All disinfectants must be registered with the U. S. Environmental Protection Agency and meet specific labeling requirements.
A sanitizer is a type of anti-microbial agent that kills or irreversibly inactivates at least 99.9 percent of all microorganisms present on a surface. Sanitizers are generally appropriate for textiles and there are similar provisions for their registration with EPA.
Lastly, an anti-microbial agent also kills or inhibits the growth of specific microorganisms. Some anti-microbial agents are provided as self-sanitizer treatments that can prevent or reduce microorganism growth in clothing and other articles.
Like disinfectants and sanitizers, anti-microbial agents must have claims that are verified as to their effectiveness. EPA has enforcement authority under Federal Insecticide, Fungicide, and Rodenticide Act because products that claim to kill or repel bacteria or germs are considered pesticides, and must be registered with EPA prior to distribution or sale.
EPA will not register a pesticide until it has been tested to show that it will not pose an unreasonable risk when used according to the label directions. Therefore, emergency-response organizations should look for EPA registration number on product labels and follow label directions for use.
Verifying the claims
EPA requires specific tests for manufacturers or suppliers who make disinfection, sanitization, or self-sanitizing claims. The required testing for such claims is relatively rigorous and must be demonstrated under the proscribed conditions of use, which include the level of dilution, temperature, contact time and method of application.
These tests measure the effectiveness of the particular agent in removing specific types of microorganisms. Not all agents completely kill all organisms and may be limited in their ability to remove or inactivate specific microorganisms.
In addition, these claims can only be extended to specific uses. Thus, a disinfectant intended for cleaning a surface may not be effective on clothing textiles.
All agents must have an EPA registration number and include specific information with product label. EPA registration numbers for disinfectants, sanitizers and self-sanitizers can also be found at EPA's website. The site lists registered product by the product name, manufacturer name or EPA registration number.
EPA requires specific information be provided on labels. This includes the type of agent (limited, general purpose or broad spectrum, or hospital), each with different requirements for listing the effectiveness of the product under specific conditions, precautionary statements, hazards and first aid, and instructions for use.
Doing more good than harm
In addition to knowing whether the selected agent will actually work on clothing, it is important to determine that it will not harm the clothing. Not all providers are familiar with turnout clothing and its limitations when it comes to cleaning or sanitization.
Certainly, anything that contains chlorine-based bleach, such as sodium hypochlorite, must never be used due to its known ability to degrade several types of materials used in turnout gear. A supplier should demonstrate an agent's safety on protective clothing by testing the clothing after multiple cycles of using the agent per the given instructions.
When choosing an agent, be aware of the differences and under what conditions you can expect these agents to perform in removing any biological contamination. Always look for the EPA registration number and/or confirm existing registrations on the EPA website. Make sure that the agent is appropriate for decontaminating turnout clothing and will not have adverse effects on its performance.
Fire fighting is a dangerous activity — your clothing should not become another source of hazards.
Post Note – We appreciate the many inquiries that we receive each month for the various articles we have written. We were recently especially pleased when a firefighter made inquiries for how certain industry standards could be changed; we were able to provide advice that resulted in that firefighter submitting comments for a standard that will be considered by the respective committee.
We believe that the committees responsible for PPE standards need to hear more from fire service members outside the committee. We would like to emphasize that we are always willing to help the fire service voice its opinions in the different forums related to PPE.
Jeffrey O. and Grace G. Stull are president and vice president respectively of International Personnel Protection, Inc., which provides expertise on the design, evaluation, selection and use of personnel protective clothing, equipment and related products to end users and manufacturers. They are considered amongst the leading experts in the field of personal protective equipment. Send questions or feedback to Jeff or Grace at Jeffrey.O.Stull@FireRescue1.com. The views of the author do not necessarily reflect those of the sponsor.
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